Manager, Health Plan Quality Interventions - RN Required (Remote)

Lensa; Ann Arbor (MI); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading company is seeking a Manager for Health Plan Quality Interventions. This remote role requires an active RN license and involves overseeing quality improvement initiatives, collaborating with teams, and managing healthcare quality standards. Ideal candidates will have extensive experience in managed healthcare and a strong background in quality improvement.

Qualifications

• 5+ years in managed healthcare, including at least 2 years in health plan quality improvement.
• 2+ years' management experience leading a healthcare quality team.
• Strong knowledge of quality to drive effective change.

Responsibilities

• Plans and implements quality interventions aligned with state and federal rules.
• Leads operations and implementation of quality interventions using defined roadmaps.
• Facilitates strategic relationships with healthcare providers.

Skills

Quality Improvement

Collaboration

Data Analysis

Education

Active, unrestricted RN License

Master's Degree or higher in a clinical field, Public Health, or Healthcare

Tools

Excel

Visio

Job description

Manager, Health Plan Quality Interventions - RN Required (Remote)

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

Job Summary

Molina's Quality Improvement function oversees, plans, and implements healthcare quality improvement initiatives and education programs. It ensures maintenance of programs for members in line with prescribed quality standards, conducts data collection, reporting, and monitoring for key performance measurement activities, and manages NCQA accreditation surveys and federal/state QI compliance activities.

Knowledge/Skills/Abilities

The Manager, Health Plan Quality Interventions, develops, implements, and monitors quality improvement interventions. The role involves coordinating resources and training within the health plan, identifying barriers to goals, implementing and analyzing intervention strategies, and facilitating stakeholder input through the interventions Joint Operations Committee, which includes leadership from various areas. The Manager is the primary contact for health plan interventions and leads the interventions Joint Operations Committee, representing Molina Plan Senior Leadership. Collaboration with national and regional analytics and strategic teams is essential to evaluate intervention strategies.

Note: Only individuals with an RN license are being considered at this time.

• Plans and implements quality interventions aligned with state and federal rules and best practices.
• Develops targeted performance improvement interventions, including member and provider outreach.
• Leads operations and implementation of quality interventions using a defined roadmap, timeline, and KPIs.
• Collaborates with analytics and strategic teams to review and evaluate proposed interventions.
• Communicates progress, barriers, and issues to Molina Senior Leadership and strategic teams.
• Presents summaries and action steps in meetings.
• Leads and influences cross-functional teams implementing quality interventions.
• Has strong knowledge of quality to drive effective change.
• Leads qualitative analysis, reporting, and development of program materials.
• Supports program integrity and member/provider outreach initiatives.
• Facilitates strategic relationships with healthcare providers to support clinical care and services.

Job Qualifications

Required Education

Active, unrestricted RN License.

Required Experience

5+ years in managed healthcare, including at least 2 years in health plan quality improvement or related roles. 2+ years' management experience leading a healthcare quality team. Operational knowledge of Excel and Visio.

Preferred Education

Master's Degree or higher in a clinical field, Public Health, or Healthcare.

Preferred Experience

• 3+ years' experience with member/provider outreach and quality interventions.
• Supervisory experience.
• Project management and team building experience.
• Experience developing performance measures supporting business objectives.

Preferred Certifications

• Certified Professional in Health Quality (CPHQ)
• Certified HEDIS Compliance Auditor (CHCA)

To apply, current Molina employees should use the intranet job listing. Molina Healthcare offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $155,508 annually. Actual compensation varies based on location, experience, education, and skills.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Management
• Industries: IT Services and IT Consulting

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